document.write("<!-- Web Form Generator 2.0 --><center><form method=\"post\" action=\"http://www.aweber.com/scripts/addlead.pl\"><input type=\"hidden\" name=\"meta_web_form_id\" value=\"1411650991\"><input type=\"hidden\" name=\"meta_split_id\" value=\"\"><input type=\"hidden\" name=\"unit\" value=\"mylfree\"><input type=\"hidden\" name=\"redirect\" value=\"http://www.aweber.com/thankyou-coi.htm?m=audio\" id=\"redirect_08049a2798e0c992b78f742e3924a24c\"><input type=\"hidden\" name=\"meta_redirect_onlist\" value=\"\"><input type=\"hidden\" name=\"meta_adtracking\" value=\"\"><input type=\"hidden\" name=\"meta_message\" value=\"1\"><input type=\"hidden\" name=\"meta_required\" value=\"from,name,custom Time to Call,custom Day to Call,custom Time Zone,custom Phone\"><input type=\"hidden\" name=\"meta_forward_vars\" value=\"0\"><table><tr><td colspan=2><center><div align=\"center\">Items with a * are required fields.</div><div align=\"center\">&nbsp;</div></center></td></tr><tr><td>Email *:</td><td><input type=\"text\" name=\"from\" value=\"\" size=\"20\"></td></tr><tr><td>Name *:</td><td><input type=\"text\" name=\"name\" value=\"\" size=\"20\"></td></tr><tr><td>Preferred Time *:</td><td><input type=\"text\" name=\"custom Time to Call\" value=\"\" size=\"20\"></td></tr><tr><td>Preferred Day * :</td><td><select name=\"custom Day to Call\"><option value=\"Monday\">Monday</option><option value=\"Tuesday\">Tuesday</option><option value=\"Wednesday\">Wednesday</option><option value=\"Thursday\">Thursday</option><option value=\"Friday\">Friday</option></select></td></tr><tr><td>Time Zone *:</td><td><input type=\"text\" name=\"custom Time Zone\" value=\"\" size=\"20\"></td></tr><tr><td>Phone * (I call you so you don't have to pay for long distance charges):</td><td><input type=\"text\" name=\"custom Phone\" value=\"\" size=\"20\"></td></tr><tr><td>Skype (If you live outside the U.S.A. and have Skype):</td><td><input type=\"text\" name=\"custom Skype\" value=\"\" size=\"20\"></td></tr><tr><td>If you had all the resources you need and no obstacles in your path, where would you be in 6 months:</td><td><input type=\"text\" name=\"custom 6 Months\" value=\"\" size=\"20\"></td></tr><tr><td>What's stopping you?:</td><td><input type=\"text\" name=\"custom Challenge\" value=\"\" size=\"20\"></td></tr>    <tr><td colspan=2><center></center></td></tr><tr><td align=\"center\" colspan=\"2\"><input type=\"submit\" name=\"submit\" value=\"Submit\"></td></tr></table></form></center>");

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